Sexual Healing: Surrogate Partner Therapy

By Jonathan Stewart

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<p>Would you have sex with your therapist? Playboy.com explores the sexual healing of Surrogate Partner Therapy.<br></p>


Would you have sex with your therapist? Thanks to Showtime’s TV program Masters of Sex and Helen Hunt’s Oscar-nominated film The Sessions, Surrogate Partner Therapy has surfaced as a hot topic in the last few years. Because touch and even actual sexual intercourse may be part of the treatment, this form of sex therapy is controversial. Is it just prostitution with a veneer of therapeutic respectability? Does surrogate partner therapy offer clinical value? Playboy.com spoke to a number of practitioners and advocates of Surrogate Partner Therapy to discover exactly how it works and what this unique therapy entails.

Surrogate partner therapy began with the groundbreaking sexual research work of gynecologist William Masters and sexologist Virginia Johnson in St. Louis in the 1960s and 1970s. Believing talk therapy could only do so much for clients with sexual issues, Johnson and Masters devised specific, “hands-on” therapies for common sexual problems and disorders, for instance, their “stop-start” technique for premature ejaculation: during sex the man signals to his partner that he’s about to orgasm and both partners stop and lie still until the feeling passes. 

By teaching both partners these methods, Masters and Johnson noticed vast improvements in their patients’ sex lives. Vena Blanchard is the president of the International Professional Surrogates Association (IPSA) and a sex therapist who works alongside surrogate partners in her practice. Blanchard believes that the key to Masters and Johnson’s patients’ 80 percent success rate was that they worked through the therapy as a couple. “In the course of their treatment program, they specifically concluded that it was better for people to work on these issues with a cooperative partner, therapy done in this way was very effective” Blanchard says. “Masters and Johnson witnessed a success rate of 80 percent treating couples who had sexual difficulties by using these specific methods.

But what about a single man or woman with sexual dysfunction? As Masters and Johnson’s clinical data indicated that their course of treatment worked best with couples, they came up with the idea of training partner stand-ins, a surrogate to take the role of the wife or husband during a treatment program overseen by Masters and Johnson or another trained therapist. “They found that the clients who worked with those surrogates were as successful, or more successful, in resolving their sexual concerns as the couples were,” Blanchard says. So Masters and Johnson started training surrogate partners and instructing sex therapists on how to work alongside them.

Today, Masters and Johnson are both deceased, and their institute closed in the 1990s, which leaves us with few respectable resources for training surrogate sexual partners. Legally, you can’t work as a dentist or a lawyer or a host of other professional jobs without the proper education and certification from a licensing board. Surrogate sexual partners are not regulated in this fashion—anyone can call themselves a surrogate partner and training isn’t offered at any college or counseling institution. But since 1973, the International Professional Surrogates Association, an L.A.-based nonprofit, offers certification and training.

Blanchard says the training IPSA offers, and that it requires for its members, is a two-phase program. The first phase is a classroom-style study of theoretical material, similar to what a human sexuality major would study in a college classroom, along with coaching, talk therapy elements and the experiential techniques needed to work directly with the clients. If the student passes that stage they move on to an internship, working side-by-side with a mentoring surrogate partner and an overseeing sex therapist.

With surrogate partner therapy little known to the general public, not to mention controversial due to its intimate nature, how do clients come to it? San Francisco-based surrogate partner and IPSA media chair Mark Shattuck tells us that clients are often in talk therapy, sometimes for years, and if there’s no progress the therapist will suggest bringing in a surrogate. Some of the typical issues surrogate partner therapy is used to treat include erectile dysfunction and premature ejaculation in men, and vaginismus, or involuntary contractions of the vaginal muscles that make sex painful, in women. The disabled, and those recovering from injury and illness, are another set of clientele. But, according to Shattuck, it’s most common to work with clients whose issues are more nebulous, and less strictly pathological: late-life virginity, body image issues, social phobias, intimacy issues and just general inexperience with sex, dating and courting.

“Midlife virginity is very common for both male and female clients,” says Shattuck. “You can picture that 40-year-old man with long, stringy hair; long, dirty fingernails—a computer programmer who dresses all shlumpy that has never had a relationship or never really been on a date.” But he’s quick to explain the surrogate isn’t there just to take a client’s virginity. “These clients are people who want to have a relationship but literally can’t figure out what to do, not only in sex, but in dating in general,” he says, adding, “so we assist them in learning all of the skills you need to be with another person, a lover.”

Shattuck claims that sex is only a small part of seeing a surrogate and sometimes is absent altogether. “When seeing a surrogate partner I’d say it’s common to do at least five or six sessions before you start to disrobe.” He continues, “In my experience I’ve had it go 10 or 14 sessions, especially with women.” What’s going on in the early sessions then? Talking through the client’s sexual history, role-play, practicing small talk and communication skills are often the beginning point. 

The first physical contact comes through a set of exercises devised by Masters and Johnson called “sensate focusing,” where gentle, nonsexual touching allows the client to get comfortable with both giving and receiving touch. Rebecca Torosian, a surrogate working out of New York, says sensate focusing also helps dissolve fears and hang-ups surrounding intimacy. “The focus is on the here and the now, so by doing that the client gets out of their head, out of their anxiety. It allows people to be in the moment and experience what they’re actually feeling, not what their mind is telling them; sensate focusing creates a space to begin to learn.” Torosian adds, “Like any coaching it’s about teaching behavior and changing the wiring about how you approach something.”

What the sessions progress to next depends on the client.Tamar Reilly, a surrogate partner in Malibu Beach, treats a number of men suffering from premature ejaculation. “Early ejaculation is the quickest to cure—no pun intended—by teaching clients the stop/start method,” she says. When physical causes of erectile dysfunction or vaginismus have been ruled out by a trip to the doctor, and if the disorders appear to be psychosomatic, intimate touch and confidence-building can assist in treating them.

If the course of sessions builds up to sex, every step is still taken slowly. As part of the learning process, permission is asked by both parties at every step. “The point is permission granting because if you’re having a relationship with somebody and you want to do something to them, it’s good to ask for permission,” Shattuck says. “Some will say that takes the spontaneity out of it, but in real life people like to be asked.” Though it may be a clinical situation, the sex is not cold and sterile; the point is to simulate being with a loving partner, so there’s a certain degree of passion, pleasure and warmth. Balancing out the natural and organic aspects of the sex, the surrogate verbalizes plenty of encouragement, as well as feedback and some soft suggestions for what to do and how to do it. 

Throughout the entire process, the surrogate and client work in conjunction with a sex therapist, usually the same therapist who suggested surrogate therapy in the first place. “For each client we see, we figure out with the therapist what’s best for the client,” Shattuck says, “and that everything we’re doing is only increasing the client’s comfort and confidence in a safe environment.” Reilly tells us that as a surrogate partner she’s a member of a therapeutic team. “I have to submit lengthy, detailed reports to the client’s therapist after every visit,” she says. “The intent is the long-term well-being of the client.” This triadic structure assures both clinical oversight and more resources for the client as they continue talk therapy.

A common thread among the interviewees is what they view as common misconceptions about surrogate partners. Particularly grating is the misunderstanding that it’s just about sex and that surrogate partners are prostitutes. “Seeing a prostitute is like going to a restaurant, while seeing a surrogate is like going to culinary school,” is the analogy Shattuck uses. “You have a cooking instructor show you how to put all of these ingredients together to make a great dish. And then they send you away to go make this great dish for other people. This is not for immediate gratification.” Since most insurance plans don’t cover sex therapy, and with sex being only one component of the treatment, Shattuck jokes that anyone looking just to get laid is better off going to a sex worker: it would be cheaper and guarantee sex.

The 2012 Helen Hunt movie The Sessions is another common reference point. All praise it for bringing attention to their line of work, and even though it’s based on the true story of paralyzed poet Mark O’Brien losing his virginity to surrogate Cheryl Cohen-Greene, the Hollywoodization of the story gets some elements wrong. “Helen Hunt strips off all her clothes and jumps into bed immediately. I would never do that,” says Torosian. “It was a good movie in many ways, but it focused only on the sex and didn’t portray the myriad other things we surrogates do.” Shattuck believes The Sessions generally paints his profession in a good light, but thinks it promulgates the idea that surrogate partners are only for the severely disabled, where in fact they’re available to everyone for a host of problems.

Both surrogate partners Torosian and Shattuck refer to their careers as “a calling.” Shattuck hopes a new generation will hear the same call and enter the profession. After a high point in the 1970s, the number of surrogate partners has been dropping steadily in the United States, with only about 40 currently practicing throughout the country. Shattuck views his work as making the world a better place as well as being extremely personally rewarding. Reilly echoes this sentiment, saying, “I truly enjoy helping others. Happiness is something I get from giving it away.”


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